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Didier R, Lhermusier T, Auffret V, Eltchaninoff H, Le Breton H, Cayla G, Commeau P, Collet JP, Cuisset T, Dumonteil N, Verhoye JP, Beurtheret S, Lefèvre T, Teiger E, Carrié D, Himbert D, Albat B, Cribier A, Sudre A, Blanchard D, Bar O, Rioufol G, Collet F, Houel R, Labrousse L, Meneveau N, Ghostine S, Manigold T, Guyon P, Delepine S, Favereau X, Souteyrand G, Ohlmann P, Doisy V, Beygui F, Gommeaux A, Claudel JP, Bourlon F, Bertrand B, Iung B, Gilard M. TAVR Patients Requiring Anticoagulation: Direct Oral Anticoagulant or Vitamin K Antagonist? JACC Cardiovasc Interv 2021; 14:1704-1713. [PMID: 34274294 DOI: 10.1016/j.jcin.2021.05.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Using French transcatheter aortic valve replacement (TAVR) registries linked with the nationwide administrative databases, the study compared the rates of long-term mortality, bleeding, and ischemic events after TAVR in patients requiring oral anticoagulation with direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs). BACKGROUND The choice of optimal drug for anticoagulation after TAVR remains debated. METHODS Data from the France-TAVI and FRANCE-2 registries were linked to the French national health single-payer claims database, from 2010 to 2017. Propensity score matching was used to reduce treatment-selection bias. Two primary endpoints were death from any cause (efficacy) and major bleeding (safety). RESULTS A total of 24,581 patients who underwent TAVR were included and 8,962 (36.4%) were treated with OAC. Among anticoagulated patients, 2,180 (24.3%) were on DOACs. After propensity matching, at 3 years, mortality (hazard ratio [HR]: 1.37; 95% confidence interval [CI]: 1.12-1.67; P < 0.005) and major bleeding including hemorrhagic stroke (HR: 1.64; 95% CI: 1.17-2.29; P < 0.005) were lower in patients on DOACs compared with those on VKAs. The rates of ischemic stroke (HR: 1.32; 95% CI: 0.81-2.15; P = 0.27) and acute coronary syndrome (HR: 1.17; 95% CI: 0.68-1.99; P = 0.57) did not differ among groups. CONCLUSIONS In these large multicenter French TAVR registries with an exhaustive clinical follow-up, the long-term mortality and major bleeding were lower with DOACs than VKAs at discharge. The present study supports preferential use of DOACs rather than VKAs in patients requiring oral anticoagulation therapy after TAVR.
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Affiliation(s)
- Romain Didier
- Department of Cardiology, Brest University Hospital, Brest, France
| | | | | | | | | | | | | | - Jean Philippe Collet
- Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | | | | | | | - Emmanuel Teiger
- University Hospital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Dominique Himbert
- Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Bernard Albat
- University Hospital of Montpellier, Montpellier, France
| | | | | | - Didier Blanchard
- University Hospital Paris Ouest, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | | | - Remi Houel
- Saint Joseph Hospital, Marseille, France
| | | | | | - Said Ghostine
- Hospital Marie Lannelongue, Le Plessis-Robinson, France
| | - Thibaut Manigold
- University of Nantes, Department of Cardiologie, Saint-Herblain, France
| | | | | | - Xavier Favereau
- Private Hospital of Parly II, Le Chesnay-Rocquencourt, France
| | | | | | | | | | | | | | | | - Bernard Bertrand
- Department of Cardiology, Grenoble Alpes University Hospital, Grenoble, France
| | - Bernard Iung
- Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Martine Gilard
- Department of Cardiology, Brest University Hospital, Brest, France.
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2
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Akodad M, Aldhaheri E, Marin G, Roubille F, Macia JC, Gandet T, Delseny D, Schmutz L, Lattuca B, Robert P, Dubard A, Robert G, Targosz F, Maupas E, Albat B, Cayla G, Leclercq F. Transcatheter aortic valve replacement performed with selective telemetry monitoring: A prospective study. Int J Cardiol 2021; 330:158-163. [PMID: 33621627 DOI: 10.1016/j.ijcard.2021.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/26/2021] [Accepted: 02/11/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Telemetry monitoring (TM) with or without intensive care unit (ICU) admission is the standard of care after Transcatheter aortic valve replacement (TAVR). Regarding to improvements of the technique and procedural results, TM may be considered only in selected patients. We aimed to confirm feasibility and safety of selective TM in patients undergoing TAVR. METHODS We prospectively evaluated 449 consecutive patients undergoing TAVR. Patients were transferred to general cardiology ward (GCW) without TM after the procedure when stable clinical state, transfemoral access, no baseline right bundle branch block (RBBB), left ventricular ejection fraction (LVEF) > 40%, and no complication including any electrocardiogram (ECG) change within 1 h after the procedure ("low-risk" group). Others patients were considered for TM in ICU ("high-risk" group). The primary endpoint evaluated in-hospital major adverse events after unit admission according to VARC-2 criteria. RESULTS The mean age was 81.8 ± 7.5 years and mean EuroSCORE II was 7.5 ± 4.8%. In total, 116 patients (25.8%) were considered as "low-risk" patients and 163 patients (36.3%) were referred to GCW, including those with immediate pacemaker implantation. A total of 96 patients (21.3%) reached the primary endpoint including mainly conductive disorders (12.8%). No major adverse events, particularly no late severe conductive disorder, occurred in the "low-risk" group (negative predictive value of 100%). Baseline RBBB (p < 0.01), LVEF < 40% (p = 0.02) and "high-risk" group (p < 0.01) were predictive of outcomes. CONCLUSIONS Using rigorous periprocedural selection criteria, patients' admission in GCW without TM can be routinely and safely performed in 1/3 of patients after TAVR.
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Affiliation(s)
- Mariama Akodad
- Department of Cardiology, CHU Montpellier, Montpellier University, Montpellier, France; PhyMedExp, Université de Montpellier, INSERM, CNRS, France, France
| | - Eissa Aldhaheri
- Department of Cardiology, CHU Montpellier, Montpellier University, Montpellier, France
| | - Gregory Marin
- Department of Medical Information, University Hospital of Montpellier, France
| | - François Roubille
- Department of Cardiology, CHU Montpellier, Montpellier University, Montpellier, France; PhyMedExp, Université de Montpellier, INSERM, CNRS, France, France
| | - Jean-Christophe Macia
- Department of Cardiology, CHU Montpellier, Montpellier University, Montpellier, France
| | - Thomas Gandet
- Department of Cardiovascular Surgery, University Hospital of Montpellier, France
| | - Delphine Delseny
- Department of Cardiology, CHU Montpellier, Montpellier University, Montpellier, France
| | - Laurent Schmutz
- Department of Cardiology, CHU Nimes, Montpellier University, Nimes, France
| | - Benoit Lattuca
- Department of Cardiology, CHU Nimes, Montpellier University, Nimes, France
| | - Pierre Robert
- Department of Cardiology, CHU Montpellier, Montpellier University, Montpellier, France
| | | | | | | | | | - Bernard Albat
- Department of Cardiovascular Surgery, University Hospital of Montpellier, France
| | - Guillaume Cayla
- Department of Cardiology, CHU Nimes, Montpellier University, Nimes, France
| | - Florence Leclercq
- Department of Cardiology, CHU Montpellier, Montpellier University, Montpellier, France.
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Akodad M, Roubille F, Marin G, Lattuca B, Macia JC, Delseny D, Gandet T, Robert P, Schmutz L, Piot C, Maupas E, Robert G, Targosz F, Albat B, Cayla G, Leclercq F. Myocardial Injury After Balloon Predilatation Versus Direct Transcatheter Aortic Valve Replacement: Insights From the DIRECTAVI Trial. J Am Heart Assoc 2020; 9:e018405. [PMID: 33297821 PMCID: PMC7955361 DOI: 10.1161/jaha.120.018405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Myocardial injury is associated with higher mortality after transcatheter aortic valve replacement (TAVR) and might be increased by prior balloon aortic valvuloplasty (BAV). We aimed to evaluate the impact of prior BAV versus direct prosthesis implantation on myocardial injury occurring after (TAVR) with balloon-expandable prostheses. Methods and Results The DIRECTAVI (Direct Transcatheter Aortic Valve Implantation) trial, an open-label randomized study, demonstrated noninferiority of TAVR without BAV (direct TAVR group) compared with systematic BAV (BAV group) with the Edwards SAPIEN 3 valve. High-sensitivity troponin was assessed before and the day after the procedure. Incidence of myocardial injury after the procedure (high-sensitivity troponin elevation >15× the upper reference limit [14 ng/L]) was the main end point. Impact of myocardial injury on 1-month adverse events (all-cause mortality, stroke, major bleeding, major vascular complications, transfusion, acute kidney injury, heart failure, pacemaker implantation, and aortic regurgitation) was evaluated. Preprocedure and postprocedure high-sensitivity troponin levels were available in 211 patients. The mean age of patients was 83 years (78-87 years), with 129 men (61.1%). Mean postprocedure high-sensitivity troponin was 124.9±81.4 ng/L in the direct TAVR group versus 170.4±127.7 ng/L in the BAV group (P=0.007). Myocardial injury occurred in 42 patients (19.9%), including 13 patients (12.2%) in the direct TAVR group and 29 (27.9%) in the BAV group (P=0.004). BAV increased by 2.8-fold (95% CI, 1.4-5.8) myocardial injury probability. Myocardial injury was associated with 1-month adverse events (P=0.03). Conclusions BAV increased the incidence and magnitude of myocardial injury after TAVR with new-generation balloon-expandable valves. Myocardial injury was associated with 1-month adverse events. These results argue in favor of direct SAPIEN 3 valve implantation. Registration URL: https://www.Clinicaltrials.gov; Unique identifier: NCT02729519.
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Affiliation(s)
- Mariama Akodad
- Department of Cardiology Montpellier University Hospital Montpellier France.,PhyMedExp INSERM U1046CNRS UMR 9214 Montpellier France
| | - François Roubille
- Department of Cardiology Montpellier University Hospital Montpellier France.,PhyMedExp INSERM U1046CNRS UMR 9214 Montpellier France
| | - Gregory Marin
- Department of Medical Information Montpellier University Hospital Montpellier France
| | - Benoit Lattuca
- Department of Cardiology CHU NimesMontpellier University Nimes France
| | | | - Delphine Delseny
- Department of Cardiology Montpellier University Hospital Montpellier France
| | - Thomas Gandet
- Department of Cardiovascular Surgery University Hospital of Montpellier France
| | - Pierre Robert
- Department of Cardiology Montpellier University Hospital Montpellier France
| | - Laurent Schmutz
- Department of Cardiology CHU NimesMontpellier University Nimes France
| | | | | | | | | | - Bernard Albat
- Department of Cardiovascular Surgery University Hospital of Montpellier France
| | - Guillaume Cayla
- Department of Cardiology CHU NimesMontpellier University Nimes France
| | - Florence Leclercq
- Department of Cardiology Montpellier University Hospital Montpellier France
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Abetti A, Gandet T, Amri AAA, Ibrahimi MO, Rouviere P, Meilhac A, Agullo A, Demaria R, Frapier JM, Albat B. Ruptured right Valsalva sinus into the right atrium due to infective endocarditis: a case report. Pan Afr Med J 2020; 37:65. [PMID: 33244328 PMCID: PMC7680238 DOI: 10.11604/pamj.2020.37.65.21491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 08/28/2020] [Indexed: 11/15/2022] Open
Abstract
Rupture of Valsalva sinus remains a very rare and deadly complication of Valsalva sinus aneurysm with a high mortality rate. We report here the case of a 47-year-old man who presented to the emergency department with acute exercise-induced dyspnea, chest pain, and fever. Transthoracic (TTE) and transesophageal echocardiography (TEE) highlighted a rupture of the right Valsalva sinus in the right atrium due to infective endocarditis. After stabilization of the patient, a successful surgical repair with double pericardial patches was performed.
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Affiliation(s)
- Ayoub Abetti
- Department of Cardiovascular Surgery, Arnaud de Villeneuve Hospital, University Hospital of Montpellier, Montpellier, France.,Department of Cardiovascular Surgery, Mohammed VI University Medical Center, Mohammed the First University Oujda, Oujda, Morocco
| | - Thomas Gandet
- Department of Cardiovascular Surgery, Arnaud de Villeneuve Hospital, University Hospital of Montpellier, Montpellier, France
| | - Abdul Aziz Al Amri
- Department of Cardiovascular Surgery, Arnaud de Villeneuve Hospital, University Hospital of Montpellier, Montpellier, France
| | - Marouane Ouazzani Ibrahimi
- Department of Cardiovascular Surgery, Arnaud de Villeneuve Hospital, University Hospital of Montpellier, Montpellier, France
| | - Philippe Rouviere
- Department of Cardiovascular Surgery, Arnaud de Villeneuve Hospital, University Hospital of Montpellier, Montpellier, France
| | - Alexandra Meilhac
- Department of Cardiovascular Surgery, Arnaud de Villeneuve Hospital, University Hospital of Montpellier, Montpellier, France.,Department of Cardiology, Arnaud de Villeneuve Hospital, University Hospital of Montpellier, Montpellier, France
| | - Audrey Agullo
- Department of Cardiovascular Surgery, Arnaud de Villeneuve Hospital, University Hospital of Montpellier, Montpellier, France.,Department of Cardiology, Arnaud de Villeneuve Hospital, University Hospital of Montpellier, Montpellier, France
| | - Roland Demaria
- Department of Cardiovascular Surgery, Arnaud de Villeneuve Hospital, University Hospital of Montpellier, Montpellier, France
| | - Jean Marc Frapier
- Department of Cardiovascular Surgery, Arnaud de Villeneuve Hospital, University Hospital of Montpellier, Montpellier, France
| | - Bernard Albat
- Department of Cardiovascular Surgery, Arnaud de Villeneuve Hospital, University Hospital of Montpellier, Montpellier, France
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5
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Leclercq F, Robert P, Akodad M, Macia JC, Gandet T, Delseny D, Chettouh M, Schmutz L, Robert G, Levy G, Targosz F, Maupas E, Roubille F, Marin G, Nagot N, Albat B, Lattuca B, Cayla G. Prior Balloon Valvuloplasty Versus Direct Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2020; 13:594-602. [DOI: 10.1016/j.jcin.2019.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/06/2019] [Accepted: 12/03/2019] [Indexed: 10/24/2022]
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Lattuca B, Meilhac A, Akodad M, Robert C, Vandenberghe D, Manna F, Nagot N, Chettouh M, Gandet T, Macia J, Delseny D, Schmutz L, Albat B, Cayla G, Leclercq F. Eight-year clinical outcome and valve durability after trans-catheter aortic-valve implantation. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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7
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Akodad M, Meilhac A, Lefèvre T, Cayla G, Autissier C, Duflos C, Gandet T, Macia J, Delseny D, Maupas E, Schmutz L, Piot C, Targosz F, Robert G, Rivalland F, Albat B, Chevalier B, Leclercq F. Hemodynamic performances and clinical outcomes in patients undergoing valve-in-valve versus native transcatheter aortic-valve Implantation. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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8
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Choteau R, Leclercq F, Akodad M, Macia J, Chamard C, Albat B, Cayla G, Gandet T. Comparison of transcarotid vs. complex transfemoral access in patients undergoing transcatheter aortic-valve implantation (TAVI). Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Robert P, Leclercq F, Lattuca B, Albat B, Maupas E, Robert G, Akodad M, Macia JC, Dubar A, Targosz F, Gandet T, Cayla G. P1843Transcatheter aortic valve implantation in patients with uninterrupted vitamin k antagonist. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Bridging of vitamin K antagonist (VKA) with heparin is usually not promoted during interventional or surgical procedures related to increased risk of bleeding and thrombotic events but this strategy has not been evaluated during TAVI.
Purpose
The aim of this study was to evaluate the rate of major bleeding and vascular complications after TAVI performed in patients with uninterrupted VKA.
Methods
From January 2016 to October 2017, consecutive patients who underwent TAVI with uninterrupted VKA (INR between 1.5 and 3.5) were prospectively included in a monocentric registry. TAVI were performed according to current guidelines and a 50UI/kg bolus of heparin was injected at the beginning of the procedure for all patients. Vascular and bleeding complications were assessed using the Valve Academic Research Consortium 2 (VARC2) and the Bleeding Academic Research Consortium (BARC) definitions at 30 day follow-up.
Results
A total of 88 patients were included with a median age of 84 years [81.8–87], 42% being female, the median STS score was 5.1 [4.1–7.5], the median CHADS2-VASc was 5.5 [5–6] and 60.2% had a chronic kidney failure. Median INR at time of implantation was at 2.1 [1.8–2.6]. VKA were used for atrial fibrillation (89.8%), mechanic mitral prosthesis (5.7%) or venous thromboembolic disease (4.5%). Trans femoral access was used in 88.6% of the patients. Major bleeding (BARC ≥3b) occurred in 5 patients (5,7%) and major vascular complications occurred in 7 patients (8%). Peripheral arterial disease (RR = 10.95; 95% CI: 1.63 to 73.75; p=0.014) and carotid access (RR=8.56; 95% CI: 1.19 to 61.51; p=0.033) were significantly associated with major bleeding. INR >2.5 was significantly associated with vascular complications (RR=7.14; 95% CI: 1.29 to 39.63; p=0.025). In multivariate analysis, Body mass index (OR=1.26; 95% CI: 1.02 to 1.57; p=0.032) and INR >2.5 (OR=18.91; 95% CI: 1.62 to 221.26; p=0.010) were independent factor significantly associated with vascular complications or major bleeding. Mortality rate at 30 days follow-up was 2.3%, there was no myocardial infarction and stroke rate was 4.5%.
Figure 1. Study flowchart
Conclusion
TAVI with uninterrupted VKA treatment seems to be feasible and safe with low risk of bleeding and vascular complications in this first single centre experience. Particular caution is advocated in low BMI patients and to keep INR<2.5.
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Affiliation(s)
- P Robert
- University Hospital Arnaud de Villeneuve, Cardiology Department, Montpellier, France
| | - F Leclercq
- University Hospital Arnaud de Villeneuve, Cardiology Department, Montpellier, France
| | - B Lattuca
- University Hospital of Nimes, Nimes, France
| | - B Albat
- University Hospital Arnaud de Villeneuve, Cardiac Surgery, Montpellier, France
| | - E Maupas
- Franciscaines clinic, Nimes, France
| | - G Robert
- Saint-Pierre Clinic, Perpignan, France
| | - M Akodad
- University Hospital Arnaud de Villeneuve, Cardiology Department, Montpellier, France
| | - J C Macia
- University Hospital Arnaud de Villeneuve, Cardiology Department, Montpellier, France
| | - A Dubar
- Millénaire Clinic, Montpellier, France
| | - F Targosz
- University Hospital Arnaud de Villeneuve, Cardiology Department, Montpellier, France
| | - T Gandet
- University Hospital Arnaud de Villeneuve, Cardiac Surgery, Montpellier, France
| | - G Cayla
- University Hospital of Nimes, Nimes, France
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10
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Lattuca B, Meilhac A, Robert C, Vandenbergh D, Manna F, Nagot N, Chettouh M, Akodad M, Gandet T, Macia JC, Delseny D, Schmutz L, Albat B, Cayla G, Leclercq F. P1793Eight-year clinical outcome and valve durability after transcatheter aortic valve implantation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
With the growing indications of transcatheter aortic valve implantation (TAVI) worldwide and among lower risk patients, valve durability has become a crucial issue.
Purpose
To assess mid and long-term evolution of different generations of percutaneous balloon-expandable prostheses, predictive factors of valve deterioration and its correlation with long-term mortality.
Methods
All consecutive patients undergoing TAVI for severe aortic stenosis with balloon-expandable prosthesis between 2009 and 2014 and with a minimum follow-up of one-year were included in this monocentric prospective study. All echocardiograms were reviewed by two independent experts. Clinical events were defined according to the Valve Academic Research Consortium criteria. Valve deterioration was defined according to the 2017 EAPCI-ESC-EACTS international consensus statement at the longest follow-up.
Results
A total of 160 patients were included with a median follow-up of 3.4 years [1.5–4.9] and a maximum of 8 years. Patients were mostly implanted with the first generation Sapien XT valve (n=138, 86.2%). Median age was 85 [79–86] years, with 42.5% of women and a median logistic Euro-SCORE of 14.2% [10.6–23.2]. Immediately after TAVI, mean aortic gradient decreased dramatically from 51±12mmHg to 9±2.6mmHg (p<0.0001) and remained overall stable with a mean gradient of 12±1mmHg at 8 years. Valve deterioration occurred in 5.6% (n=9) of patients, of which 3.7% (n=6) with severe deterioration. Moderate or severe peri-prosthetic aortic regurgitation was observed in 2.5% (n=4) of patients. The eight-year survival rate was 12.9%. During follow-up, hospitalization for acute heart failure was required for 23.7% (n=38) of patients, a myocardial infarction or a stroke occurred respectively among 1.9% (n=3) and 5% (n=8) of patients. After multivariate analysis, size or generation of valves were not independent predictive factors of valve deterioration.
Evolution of mean aortic gradient
Conclusions
After a maximal 8-year follow-up, valve deterioration after balloon-expandable TAVI is very low. In this high-risk population, TAVI seems to be a safe and durable alternative to surgery in severe aortic stenosis regardless of prosthesis generation.
Acknowledgement/Funding
Edwards Lifesciences
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Affiliation(s)
- B Lattuca
- University Hospital of Nimes, Nimes, France
| | - A Meilhac
- University Hospital Arnaud de Villeneuve, Montpellier, France
| | - C Robert
- University Hospital of Nimes, Nimes, France
| | - D Vandenbergh
- University Hospital Arnaud de Villeneuve, Montpellier, France
| | - F Manna
- University Hospital of Montpellier, Montpellier, France
| | - N Nagot
- University Hospital of Montpellier, Montpellier, France
| | - M Chettouh
- University Hospital Arnaud de Villeneuve, Montpellier, France
| | - M Akodad
- University Hospital Arnaud de Villeneuve, Montpellier, France
| | - T Gandet
- University Hospital Arnaud de Villeneuve, Montpellier, France
| | - J C Macia
- University Hospital Arnaud de Villeneuve, Montpellier, France
| | - D Delseny
- University Hospital Arnaud de Villeneuve, Montpellier, France
| | - L Schmutz
- University Hospital of Nimes, Nimes, France
| | - B Albat
- University Hospital Arnaud de Villeneuve, Montpellier, France
| | - G Cayla
- University Hospital of Nimes, Nimes, France
| | - F Leclercq
- University Hospital Arnaud de Villeneuve, Montpellier, France
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11
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Akodad M, Meilhac A, Lefèvre T, Cayla G, Lattuca B, Autissier C, Duflos C, Gandet T, Macia JC, Delseny D, Roubille F, Maupas E, Schmutz L, Piot C, Targosz F, Robert G, Rivalland F, Albat B, Chevalier B, Leclercq F. Hemodynamic Performances and Clinical Outcomes in Patients Undergoing Valve-in-Valve Versus Native Transcatheter Aortic Valve Implantation. Am J Cardiol 2019; 124:90-97. [PMID: 31076081 DOI: 10.1016/j.amjcard.2019.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/22/2019] [Accepted: 04/01/2019] [Indexed: 10/27/2022]
Abstract
Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) emerged has a less invasive treatment than surgery for patients with degenerated bioprosthesis. However, few data are currently available regarding results of ViV versus TAVI in native aortic valve. We aimed to compare hemodynamic performances and 1-year outcomes between patients who underwent ViV procedure and patients who underwent non-ViV TAVI. This bicentric study included all patients who underwent aortic ViV procedure for surgical bioprosthetic aortic failure between 2013 and 2017. All patients who underwent TAVI were included in the analysis during the same period. ViV and non-ViV patients were matched with 1:2 ratio according to size, type of TAVI device, age (±5 years), sex, and STS score. Primary end point was hemodynamic performance including mean aortic gradient and aortic regurgitation at 1-year follow-up. A total of 132 patients were included, 49 in the ViV group and 83 in the non-ViV group. Mean age was 82.8 ± 5.9 years, 55.3% were female. Mean STS score was 5.2% ± 3.1%. Self-expandable valves were implanted in 78.8% of patients. At 1-year follow-up, aortic mean gradient was significantly higher in ViV group (18.1 ± 9.4 mm Hg vs 11.4 ± 5.4 mm Hg; p < 0.0001) and 17 (38.6%) patients had a mean aortic gradient ≥20 mm Hg vs 6 (7.8%) in the non-ViV group (p = 0.0001). Aortic regurgitation > grade 2 were similar in both groups (p = 0.71). In the ViV group, new pacemaker implantation was less frequent (p = 0.01) and coronary occlusions occurred only in ViV group (n = 2 [4.1%]). At 1-year follow-up, 3 patients (2.3%) died from cardiac cause, 1 (2.1%) in the ViV group vs 2 (2.4%) in the non-ViV group (p = 0.9). There was no stroke. In conclusion, compared with TAVI in native aortic stenosis, ViV appears as a safe and feasible strategy in patients with impaired bioprosthesis. As 1-year hemodynamic performances seem better in native TAVI procedure, long-term follow-up should be assessed to determinate the impact of residual stenosis on outcomes and durability.
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12
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de Heer F, Kluin J, Elkhoury G, Jondeau G, Enriquez-Sarano M, Schäfers HJ, Takkenberg JJ, Lansac E, Dinges C, Steindl J, Ziller R, De Kerchove L, Benkacem T, Coulon C, Elkhoury G, Kaddouri F, Vanoverschelde JL, de Meester C, Pasquet A, Nijs J, Van Mosselvelde V, Loeys B, Meuris B, Schepmans E, Van den Bossche K, Verbrugghe P, Goossens W, Gutermann H, Pettinari M, El-Hamamsy I, Lenoir M, Noly PE, Tousch M, Shah P, Boodhwani M, Rudez I, Baric D, Unic D, Varvodic J, Gjorgijevska S, Vojacek J, Zacek P, Karalko M, Hlubocky J, Novotny R, Slautin A, Soliman S, Arnaud-Crozat E, Boignard A, Fayad G, Bouchot O, Albat B, Leguerrier A, Doguet F, Fuzellier JF, Glock Y, Jondeau G, Fernandez G, Chatel D, Zeitoun DM, Jouan J, Di Centa I, Obadia JF, Leprince P, Houel R, Bergoend E, Lopez S, Berrebi A, Tubach F, Lansac E, Lejeune S, Monin JL, Pousset S, Mankoubi L, Noghin M, Diakov C, Czytrom D, Schäfers HJ, Borger M, Aicher D, Theisohn F, Ferrero P, Stoica S, Matuszewski M, Yiu P, Bashir M, Ceresa F, Patane F, De Paulis R, Chirichilli I, Masat M, Antona C, Contino M, Mangini A, Romagnoni C, Grigioni F, Rosa R, Okita Y, Miyairi T, Kunihara T, de Heer F, Koolbergen D, Marsman M, Gökalp A, Kluin J, Bekkers J, Duininck L, Takkenberg JJ, Klautz R, Van Brakel T, Arabkhani B, Mecozzi G, Accord R, Jasinski M, Aminov V, Svetkin M, Kolesar A, Sabol F, Toporcer T, Bibiloni I, Rábago G, Alvarez-Asiain V, Melero A, Sadaba R, Aramendi J, Crespo A, Porras C, Evangelista Masip A, Kelley S, Bavaria J, Milewski R, Moeller P, Wenger I, Enriquez-Sarano M, Alger S, Alger A, Leavitt K. AVIATOR: An open international registry to evaluate medical and surgical outcomes of aortic valve insufficiency and ascending aorta aneurysm. J Thorac Cardiovasc Surg 2019; 157:2202-2211.e7. [DOI: 10.1016/j.jtcvs.2018.10.076] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/02/2018] [Accepted: 10/16/2018] [Indexed: 01/08/2023]
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13
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Eliet J, Gaudard P, Zeroual N, Rouvière P, Albat B, Mourad M, Colson PH. Effect of Impella During Veno-Arterial Extracorporeal Membrane Oxygenation on Pulmonary Artery Flow as Assessed by End-Tidal Carbon Dioxide. ASAIO J 2019; 64:502-507. [PMID: 28953197 DOI: 10.1097/mat.0000000000000662] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Peripheral veno-arterial extracorporeal membrane oxygenation (VA ECMO) exposes the patient to a pulmonary blood flow bypass and a left ventricle afterload increase. Impella, a catheter-mounted microaxial rotary pump, has been proposed for left ventricle (LV) unloading in combination with VA ECMO. In order to assess the effect of Impella on pulmonary flow and LV preload, we checked Doppler pulmonary artery velocity-time integral (pVTI) and LV diastolic diameter (LVED) by transesophageal echocardiography and end-tidal carbon dioxide (EtCO2) during a step-by-step increase in Impella flow (Impella ramp test). From 134 patients on VA ECMO retrieved from our database, 27 (20%) have benefited secondary Impella implantation, out of which 11 patients had available EtCO2, pVTI, and LVED measurements at various levels of Impella speeds. We observed a proportional increases in pVTI and EtCO2 and decrease in LVED (p ≤ 0.001) during Impella flow increase. There was a significant correlation between EtCO2 and pVTI (Pearson correlation coefficient 0.64; p = 0.006). The study shows that Impella improves pulmonary flow, an effect that can be easily measured by EtCO2 monitoring, and ensures LV discharge, allowing adapting Impella flow adequately to patient's individual needs.
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Affiliation(s)
- Jacob Eliet
- From the Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Academic Hospital, F-34295 Montpellier, France
| | - Philippe Gaudard
- From the Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Academic Hospital, F-34295 Montpellier, France.,PhyMedExp, University of Montpellier, INSERM U1046, Montpellier, France
| | - Norddine Zeroual
- From the Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Academic Hospital, F-34295 Montpellier, France
| | - Philippe Rouvière
- Department of Cardiac Surgery, Arnaud de Villeneuve Academic Hospital, F-34295 Montpellier, France
| | - Bernard Albat
- Department of Cardiac Surgery, Arnaud de Villeneuve Academic Hospital, F-34295 Montpellier, France
| | - Marc Mourad
- From the Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Academic Hospital, F-34295 Montpellier, France
| | - Pascal H Colson
- From the Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Academic Hospital, F-34295 Montpellier, France.,Institut de Génomique Fonctionnelle, Department of Endocrinology, CNRS UMR 5203, INSERM U1191, University of Montpellier, Montpellier, France
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Didier R, Eltchaninoff H, Donzeau-Gouge P, Chevreul K, Fajadet J, Leprince P, Leguerrier A, Lièvre M, Prat A, Teiger E, Lefevre T, Tchetché D, Carrié D, Himbert D, Albat B, Cribier A, Sudre A, Blanchard D, Rioufol G, Collet F, Houel R, Dos Santos P, Meneveau N, Ghostine S, Manigold T, Guyon P, Cuisset T, Le Breton H, Delepine S, Favereau X, Souteyrand G, Ohlmann P, Doisy V, Lognoné T, Gommeaux A, Claudel JP, Bourlon F, Bertrand B, Iung B, Gilard M. Five-Year Clinical Outcome and Valve Durability After Transcatheter Aortic Valve Replacement in High-Risk Patients. Circulation 2018; 138:2597-2607. [DOI: 10.1161/circulationaha.118.036866] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Romain Didier
- Department of Cardiology, Brest University Hospital, France (R.D., M.G.)
| | | | - Patrick Donzeau-Gouge
- Department of Cardiology and Surgery, Institut Cardiovasculaire Paris Sud, Massy, France (P.D.-G., T.L.)
| | - Karine Chevreul
- Department of Unité de Recherche Clinique en Économie de la Santé D’île-de-France and Cardiology, Creteil University, Paris, France (K.C., E.T.)
| | - Jean Fajadet
- Department of Cardiology, Clinique Pasteur, Toulouse, France (J.F., D.T.)
| | - Pascal Leprince
- Department of Surgery, Pitié Salpêtrière University Hospital, Paris, France (P.L.)
| | - Alain Leguerrier
- Department of Cardiology and Surgery, Rennes University Hospital, France (A.L., H.L.B.)
| | - Michel Lièvre
- UMR and Department of Cardiology, Lyon University Hospital, France (M.L., G.R.)
| | - Alain Prat
- Department of Cardiology and Surgery, Lille University Hospital, France (A.P., A.S.)
| | - Emmanuel Teiger
- Department of Unité de Recherche Clinique en Économie de la Santé D’île-de-France and Cardiology, Creteil University, Paris, France (K.C., E.T.)
| | - Thierry Lefevre
- Department of Cardiology and Surgery, Institut Cardiovasculaire Paris Sud, Massy, France (P.D.-G., T.L.)
| | - Didier Tchetché
- Department of Cardiology, Clinique Pasteur, Toulouse, France (J.F., D.T.)
| | - Didier Carrié
- Department of Cardiology, Toulouse University Hospital, France (D.C.)
| | - Dominique Himbert
- Department of Cardiology, AP-HP, Bichat Hospital, Paris-Diderot University, DHU Fire, France (D.H., B.I.)
| | - Bernard Albat
- Department of Surgery, Montpellier University Hospital, France (B.A.)
| | - Alain Cribier
- Department of Cardiology, Rouen University Hospital, France (H.E., A.C.)
| | - Arnaud Sudre
- Department of Cardiology and Surgery, Lille University Hospital, France (A.P., A.S.)
| | - Didier Blanchard
- Department of Cardiology, Georges Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Paris Descartes, France (D.B.)
| | - Gilles Rioufol
- UMR and Department of Cardiology, Lyon University Hospital, France (M.L., G.R.)
| | - Frederic Collet
- Department of Surgery, Clairval Hospital, Marseille, France (F.C.)
| | - Remi Houel
- Department of Cardiology, Saint Joseph Hospital, Marseille, France (R.H.)
| | - Pierre Dos Santos
- Department of Cardiology, Bordeaux University Hospital, France (P.D.S.)
| | - Nicolas Meneveau
- Department of Cardiology, Besancon University Hospital, France (N.M.)
| | - Said Ghostine
- Department of Cardiology, Centre Cardiologique Marie Lannelongue, Le Plessis-Robinson, France (S.G.)
| | - Thibaut Manigold
- Department of Cardiology, Nantes University Hospital, France (T.M.)
| | - Philippe Guyon
- Department of Cardiology, Centre Cardiologique Nord, Saint Denis, France (P.G.)
| | - Thomas Cuisset
- Department of Cardiology, Marseille University Hospital, France (T.C.)
| | - Herve Le Breton
- Department of Cardiology and Surgery, Rennes University Hospital, France (A.L., H.L.B.)
| | | | - Xavier Favereau
- Department of Cardiology, Parly 2 Hospital, Le Chesnay, France (X.F.)
| | - Geraud Souteyrand
- Department of Cardiology, Clermont Ferrand University Hospital, France (G.S.)
| | - Patrick Ohlmann
- Department of Cardiology, Strasbourg University Hospital, France (P.O.)
| | - Vincent Doisy
- Department of Surgery, Clinique du Tonkin, Lyon, France (V.D.)
| | - Thérèse Lognoné
- Department of Cardiology, Saint-Malo Hospital, France (T.L.)
| | | | | | - Francois Bourlon
- Department of Cardiology, Centre Cardio-Thoracique, Monaco (F.B.)
| | - Bernard Bertrand
- Department of Cardiology, Grenoble University Hospital, France (B.B.)
| | - Bernard Iung
- Department of Cardiology, AP-HP, Bichat Hospital, Paris-Diderot University, DHU Fire, France (D.H., B.I.)
| | - Martine Gilard
- Department of Cardiology, Brest University Hospital, France (R.D., M.G.)
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Kalmanovich E, Audurier Y, Akodad M, Mourad M, Battistella P, Agullo A, Gaudard P, Colson P, Rouviere P, Albat B, Ricci JE, Roubille F. Management of advanced heart failure: a review. Expert Rev Cardiovasc Ther 2018; 16:775-794. [PMID: 30282492 DOI: 10.1080/14779072.2018.1530112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Heart failure (HF) has become a global pandemic. Despite recent developments in both medical and device treatments, HF incidences continues to increase. The current definition of HF restricts itself to stages at which clinical symptoms are apparent. In advanced heart failure (AdHF), it is universally accepted that all patients are refractory to traditional therapies. As the number of HF patients increase, so does the need for additional treatments, with an increased proportion of patients requiring advanced therapies. Areas covered: This review discusses extensive evidence for the effect of medical treatment on HF, although the data on the effect on AdHF is scare. Authors review the relevant literature for treating AdHF patients. Furthermore, mechanical circulatory devices (MCD) have emerged as an alternative to heart transplantation and have been shown to enhance quality of life and reduce mortality therefore authors also review the current literature on the different MCD and technologies. Expert commentary: More patients will need advanced therapies, as the access to heart transplantation is limited by the number of available donors. AdHF patients should be identified timely since the window of opportunities for advanced therapy is narrow as their morbidity is progressive and survival is often short.
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Affiliation(s)
- Eran Kalmanovich
- a Department of Cardiology , Montpellier University Hospital , Montpellier , France
| | - Yohan Audurier
- b Pharmacy Department , University Hospital of Montpellier , Montpellier , France
| | - Mariama Akodad
- a Department of Cardiology , Montpellier University Hospital , Montpellier , France
| | - Marc Mourad
- c Department of Anesthesiology and Critical Care Medicine , Arnaud de Villeneuve Hospital , Montpellier , France.,d PhyMedExp , University of Montpellier , Montpellier , France
| | - Pascal Battistella
- a Department of Cardiology , Montpellier University Hospital , Montpellier , France
| | - Audrey Agullo
- a Department of Cardiology , Montpellier University Hospital , Montpellier , France
| | - Philippe Gaudard
- c Department of Anesthesiology and Critical Care Medicine , Arnaud de Villeneuve Hospital , Montpellier , France.,d PhyMedExp , University of Montpellier , Montpellier , France
| | - Pascal Colson
- c Department of Anesthesiology and Critical Care Medicine , Arnaud de Villeneuve Hospital , Montpellier , France.,d PhyMedExp , University of Montpellier , Montpellier , France
| | - Philippe Rouviere
- e Department of Cardiovascular Surgery , University Hospital of Montpellier, University of Montpellier , Montpellier , France
| | - Bernard Albat
- e Department of Cardiovascular Surgery , University Hospital of Montpellier, University of Montpellier , Montpellier , France
| | - Jean-Etienne Ricci
- f Department of Cardiology , Nîmes University Hospital, University of Montpellier , Nîmes , France
| | - François Roubille
- a Department of Cardiology , Montpellier University Hospital , Montpellier , France.,d PhyMedExp , University of Montpellier , Montpellier , France
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16
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Canaud L, Albat B, Hireche K, Hostalrich A, Alric P, Gandet T. Reverse extra-anatomic aortic arch debranching procedure allowing thoracic endovascular aortic repair of a chronic ascending aortic aneurysm. J Vasc Surg Cases Innov Tech 2018; 4:102-105. [PMID: 29942892 PMCID: PMC6012997 DOI: 10.1016/j.jvscit.2018.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 02/20/2018] [Indexed: 10/26/2022]
Abstract
A 79-year-old woman was admitted with a large chronic dissecting ascending aortic aneurysm starting 5 mm distal to the ostia of the left coronary artery and ending immediately proximal to the innominate artery. A reverse extra-anatomic aortic arch debranching procedure was performed. During the same operative time, through a transapical approach, a thoracic stent graft was deployed with the proximal landing zone just distal to the coronary ostia and the distal landing zone excluding the origin of the left common carotid artery. The postoperative course was uneventful. Computed tomography at 12 months documented patent extra-anatomic aortic arch debranching and no evidence of endoleak.
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Affiliation(s)
- Ludovic Canaud
- Department of Thoracic and Cardiovascular Surgery, Hôpital A de Villeneuve, Montpellier, France
| | - Bernard Albat
- Department of Thoracic and Cardiovascular Surgery, Hôpital A de Villeneuve, Montpellier, France
| | - Kheira Hireche
- Department of Thoracic and Cardiovascular Surgery, Hôpital A de Villeneuve, Montpellier, France
| | - Aurelien Hostalrich
- Department of Thoracic and Cardiovascular Surgery, Hôpital A de Villeneuve, Montpellier, France
| | - Pierre Alric
- Department of Thoracic and Cardiovascular Surgery, Hôpital A de Villeneuve, Montpellier, France
| | - Thomas Gandet
- Department of Thoracic and Cardiovascular Surgery, Hôpital A de Villeneuve, Montpellier, France
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Chatre C, Dumont Y, Morquin D, Boever CMD, Gandet T, Albat B, Reynes J, Le Moing V. Les récidives d’endocardite infectieuse à entérocoque : fréquence et facteurs favorisants. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Akodad M, Lattuca B, Agullo A, Macia JC, Gandet T, Marin G, Iemmi A, Vernhet H, Schmutz L, Nagot N, Albat B, Cayla G, Leclercq F. Prognostic Impact of Calcium Score after Transcatheter Aortic Valve Implantation Performed With New Generation Prosthesis. Am J Cardiol 2018; 121:1225-1230. [PMID: 29706182 DOI: 10.1016/j.amjcard.2018.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/12/2018] [Accepted: 02/06/2018] [Indexed: 10/18/2022]
Abstract
Calcium score (CS) is a well-known prognostic factor after transcatheter aortic valve implantation (TAVI) performed with first generation prosthesis but few data are available concerning new generation valves. The aim of this study was to evaluate if CS remains a prognostic factor after Sapien 3 and Evolut R valves implantation. Agatston CS was evaluated on multislice computed tomography before TAVI in 346 patients implanted with Sapien XT (n = 61), CoreValve (n = 57) devices, (group 1, n = 118), and with new generation Sapien 3 (n = 147), Evolut R (n = 81) prosthesis, (group 2, n = 228). Major adverse cardiovascular events and aortic regurgitation (AR) were evaluated at 1 month. The 2 groups were similar at baseline except for logistic Euroscore (20.1% in group 1 vs 15.0 % in group 2; p = 0.001), chronic renal failure (44.1% vs 37.2% respectively, p = 0.007) and preprocedural CS (4,092 ± 2,176 vs 3,682 ± 2,109 respectively, p = 0.022). In group 1, 28 patients (23.7%) had adverse clinical events vs 21 (9.2%) in group 2 (p <0.01). In multivariate analysis, a higher CS was predictive of adverse events in group 1 (5,785 ± 3,285 vs 3,565 ± 1,331 p <0.0001) but not in group 2 (p = 0.28). A higher CS was associated with AR in group 1 (6,234 ± 2711 vs 3,429 ± 1,505; p <0.001) and in patients implanted with an Evolut R device from group 2 (4,085 ± 3,645 vs 2,551 ± 1,356; p = 0.01). In conclusion, CS appears as an important prognostic factor of major events after TAVI with first generation valves but not with new generation devices. CS remains associated with AR only with new generation self-expandable Evolut R devices.
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Gandet T, Seghrouchni A, Ozdemir BA, Captier G, Demaria R, Alric P, Albat B, Canaud L. Experimental evaluation of homemade distal stent graft fenestration for thoracic endovascular aortic repair of type A dissection by a transapical approach. J Vasc Surg 2018; 68:1217-1224. [PMID: 29680298 DOI: 10.1016/j.jvs.2017.08.095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 08/25/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The use of off-the-shelf stent grafts for thoracic endovascular aortic repair of type A dissections is limited by variability in both the length of the ascending aorta and the location of the proximal intimal tear. This experimental study aimed to assess the feasibility of using a physician-modified thoracic aortic stent graft to treat acute type A dissection by a transapical cardiac approach. METHODS The experiments were performed on six cadaveric human heart, ascending aorta, aortic arch, and descending aorta specimens. Fenestration was fashioned in each standard tubular Valiant thoracic stent graft (Valiant Captivia; Medtronic Vascular, Santa Rosa, Calif) to match the anatomy of each specimen. Stent grafts of sufficient length were selected to cover the entire ascending aorta and aortic arch. Stent graft diameters in proximal sealing zones were oversized by 5% to 10%. The length of the fenestration was the distance between the left subclavian artery and the proximal edge of the origin of the brachiocephalic trunk with an additional 10 mm. The diameter of the scallop was that of the brachiocephalic trunk with an additional 5 mm on all sides. The length of the covered portion of the stent graft was the distance between coronary arteries and the proximal edge of the origin of the brachiocephalic trunk. Two lateral radiopaque markers were positioned to delineate the distal and lateral edge of the scallop. Another 3-cm radiopaque marker was sutured onto the sheath to ensure accurate radiologic positioning of the scallop on the outer curve of the aorta. The left ventricle and the thoracic aorta were connected to a benchtop aortic pulsatile flow model. A 5-mm 30-degree lens was introduced through the left subclavian artery to monitor the procedure. The customized stent graft was deployed by a transapical approach under fluoroscopic control. RESULTS Median duration of stent graft modification was 21 minutes (range, 17-40 minutes). All attempts to deploy the homemade proximal scalloped stent graft by a transapical approach were successful. Completion angiography demonstrated patency of the supra-aortic trunks and of the coronary arteries in all cases. Macroscopic evaluation did not identify any deterioration of the customized stent graft. CONCLUSIONS The use of physician-modified stent grafts is feasible for thoracic endovascular aortic repair of type A dissection by a transapical approach in this model.
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Affiliation(s)
- Thomas Gandet
- Department of Cardiac and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.
| | - Anis Seghrouchni
- Department of Cardiac and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Baris Ata Ozdemir
- Department of Cardiac and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Guillaume Captier
- Department of Cardiac and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Roland Demaria
- Department of Cardiac and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Pierre Alric
- Department of Cardiac and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Bernard Albat
- Department of Cardiac and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Ludovic Canaud
- Department of Cardiac and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France
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Robert P, Macia JC, Albat B, Lattuca B, Labour J, Akodad M, Gandet T, Schmutz L, Delseny D, Maupas E, Piot C, Targosz F, Robert G, Cayla G, Leclercq F. PRIOR BALLOON VALVULOPLASTY VERSUS DIRECT TRANSCATHETER AORTIC VALVE IMPLANTATION (DIRECTAVI): PRELIMINARY FINDINGS ON THE FIRST 128 RANDOMIZED PATIENTS. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31677-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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21
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Romano-Bertrand S, Evrevin M, Dupont C, Frapier JM, Sinquet JC, Bousquet E, Albat B, Jumas-Bilak E. Persistent contamination of heater-cooler units for extracorporeal circulation cured by chlorhexidine-alcohol in water tanks. J Hosp Infect 2018; 99:290-294. [PMID: 29331660 DOI: 10.1016/j.jhin.2018.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/05/2018] [Indexed: 11/19/2022]
Abstract
Recently, surgical site infections due to non-tuberculous mycobacteria (NTM) have been linked to heater-cooler unit contamination. The European Centre for Disease Prevention and Control and manufacturers now recommend the use of hydrogen peroxide in filtered water to fill heater-cooler unit tanks. After implementation of these measures in our hospital, heater-cooler units became heavily contaminated by opportunistic waterborne pathogens such as Pseudomonas aeruginosa and Stenotrophomonas maltophilia. No NTM were detected but fast-growing resistant bacteria could impair their detection. The efficiency of hydrogen peroxide and chlorhexidine-alcohol was compared in situ. Chlorhexidine-alcohol treatment stopped waterborne pathogen contamination and NTM were not cultured whereas their detection efficiency was probably improved.
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Affiliation(s)
- S Romano-Bertrand
- Hydrosciences Montpellier, IRD, CNRS, Univ Montpellier, Département d'Hygiène Hospitalière, CHU Montpellier, Montpellier, France.
| | - M Evrevin
- Département d'Hygiène Hospitalière, CHU Montpellier, Montpellier, France
| | - C Dupont
- Hydrosciences Montpellier, IRD, CNRS, Univ Montpellier, Montpellier, France
| | - J-M Frapier
- PhyMedExp, INSERM, CNRS, Univ Montpellier, Service de Chirurgie Thoracique et Cardiovasculaire, CHU Montpellier, Montpellier, France
| | - J-C Sinquet
- PhyMedExp, INSERM, CNRS, Univ Montpellier, Service de Chirurgie Thoracique et Cardiovasculaire, CHU Montpellier, Montpellier, France
| | - E Bousquet
- Département d'Hygiène Hospitalière, CHU Montpellier, Montpellier, France
| | - B Albat
- PhyMedExp, INSERM, CNRS, Univ Montpellier, Service de Chirurgie Thoracique et Cardiovasculaire, CHU Montpellier, Montpellier, France
| | - E Jumas-Bilak
- Hydrosciences Montpellier, IRD, CNRS, Univ Montpellier, Département d'Hygiène Hospitalière, CHU Montpellier, Montpellier, France
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Leclercq F, Robert P, Labour J, Lattuca B, Akodad M, Macia JC, Gervasoni R, Roubille F, Gandet T, Schmutz L, Nogue E, Nagot N, Albat B, Cayla G. Prior balloon valvuloplasty versus DIRECT transcatheter Aortic Valve Implantation (DIRECTAVI): study protocol for a randomized controlled trial. Trials 2017; 18:303. [PMID: 28676065 PMCID: PMC5496363 DOI: 10.1186/s13063-017-2036-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 06/01/2017] [Indexed: 02/06/2023] Open
Abstract
Background Balloon predilatation of the aortic valve has been regarded as an essential step during the transcatheter aortic valve implantation (TAVI) procedure. However, recent evidence has suggested that aortic valvuloplasty may cause complications and that high success rates may be obtained without prior dilatation of the valve. We hypothesize that TAVI performed without predilatation of the aortic valve and using new-generation balloon-expandable transcatheter heart valves is associated with a better net clinical benefit than TAVI performed with predilatation. Methods/design The transcatheter aortic valve implantation without prior balloon dilatation (DIRECTAVI) trial is a randomized controlled open label trial that includes 240 patients randomized to TAVI performed with prior balloon valvuloplasty (control arm) or direct implantation of the valve (test arm). All patients with an indication for TAVI will be included excepting those requiring transapical access. The trial tests the hypothesis that the strategy of direct implantation of the new-generation balloon-expandable SAPIEN 3 valve is noninferior to current medical practice using predilatation of the valve. The primary endpoint assessing efficacy and safety of the procedure consists of immediate procedural success and secondary endpoints include complications at 30-day follow-up (VARC-2 criteria). A subgroup analysis evaluates neurological ischemic events with cerebral MRI imaging (25 patients in each strategy group) performed before and between 1 and 3 days after the procedure. Discussion This prospective randomized study is designed to assess the efficacy and safety of TAVI performed without prior dilatation of the aortic valve using new-generation balloon-expandable transcatheter heart valves. We aim to provide robust evidence of the advantages of this strategy to allow the interventional cardiologist to use it in everyday practice. Trial registration ClinicalTrials.gov identifier: NCT02729519. Registered on 15 July 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2036-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Florence Leclercq
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France. .,Department of Cardiology, Arnaud de Villeneuve Hospital, University of Montpellier, Avenue du doyen Giraud, 34295, Montpellier cedex 5, France.
| | - Pierre Robert
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | - Jessica Labour
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | - Benoit Lattuca
- Department of Cardiology, University Hospital of Nimes, Nimes, France
| | - Mariama Akodad
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | | | - Richard Gervasoni
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | - Francois Roubille
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | - Thomas Gandet
- Department of Cardiovascular Surgery, University Hospital of Montpellier, Montpellier, France
| | - Laurent Schmutz
- Department of Cardiology, University Hospital of Nimes, Nimes, France
| | - Erika Nogue
- Department of Medical Information, University Hospital of Montpellier, Montpellier, France
| | - Nicolas Nagot
- Department of Medical Information, University Hospital of Montpellier, Montpellier, France
| | - Bernard Albat
- Department of Cardiovascular Surgery, University Hospital of Montpellier, Montpellier, France
| | - Guillaume Cayla
- Department of Cardiology, University Hospital of Nimes, Nimes, France
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23
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Auffret V, Lefevre T, Van Belle E, Eltchaninoff H, Iung B, Koning R, Motreff P, Leprince P, Verhoye JP, Manigold T, Souteyrand G, Boulmier D, Joly P, Pinaud F, Himbert D, Collet JP, Rioufol G, Ghostine S, Bar O, Dibie A, Champagnac D, Leroux L, Collet F, Teiger E, Darremont O, Folliguet T, Leclercq F, Lhermusier T, Olhmann P, Huret B, Lorgis L, Drogoul L, Bertrand B, Spaulding C, Quilliet L, Cuisset T, Delomez M, Beygui F, Claudel JP, Hepp A, Jegou A, Gommeaux A, Mirode A, Christiaens L, Christophe C, Cassat C, Metz D, Mangin L, Isaaz K, Jacquemin L, Guyon P, Pouillot C, Makowski S, Bataille V, Rodés-Cabau J, Gilard M, Le Breton H, Le Breton H, Eltchaninoff H, Gilard M, Iung B, Le Breton H, Lefevre T, Van Belle E, Laskar M, Leprince P, Iung B, Bataille V, Chevalier B, Garot P, Hovasse T, Lefevre T, Donzeau Gouge P, Farge A, Romano M, Cormier B, Bouvier E, Bauchart JJ, Bodart JC, Delhaye C, Houpe D, Lallemant R, Leroy F, Sudre A, Van Belle E, Juthier F, Koussa M, Modine T, Rousse N, Auffray JL, Richardson M, Berland J, Eltchaninoff H, Godin M, Koning R, Bessou JP, Letocart V, Manigold T, Roussel JC, Jaafar P, Combaret N, Souteyrand G, D’Ostrevy N, Innorta A, Clerfond G, Vorilhon C, Auffret V, Bedossa M, Boulmier D, Le Breton H, Leurent G, Anselmi A, Harmouche M, Verhoye JP, Donal E, Bille J, Joly P, Houel R, Vilette B, Abi Khalil W, Delepine S, Fouquet O, Pinaud F, Rouleau F, Abtan J, Himbert D, Urena M, Alkhoder S, Ghodbane W, Arangalage D, Brochet E, Goublaire C, Barthelemy O, Choussat R, Collet JP, Lebreton G, Leprince P, Mastrioanni C, Isnard R, Dauphin R, Dubreuil O, Durand De Gevigney G, Finet G, Harbaoui B, Ranc S, Rioufol G, Farhat F, Jegaden O, Obadia JF, Pozzi M, Ghostine S, Brenot P, Fradi S, Azmoun A, Deleuze P, Kloeckner M, Bar O, Blanchard D, Barbey C, Chassaing S, Chatel D, Le Page O, Tauran A, Bruere D, Bodson L, Meurisse Y, Seemann A, Amabile N, Caussin C, Dibie A, Elhaddad S, Drieu L, Ohanessian A, Philippe F, Veugeois A, Debauchez M, Zannis K, Czitrom D, Diakov C, Raoux F, Champagnac D, Lienhart Y, Staat P, Zouaghi O, Doisy V, Frieh JP, Wautot F, Dementhon J, Garrier O, Jamal F, Leroux PY, Casassus F, Leroux L, Seguy B, Barandon L, Labrousse L, Peltan J, Cornolle C, Dijos M, Lafitte S, Bayet G, Charmasson C, Collet F, Vaillant A, Vicat J, Giacomoni MP, Teiger E, Bergoend E, Zerbib C, Darremont O, Louis Leymarie J, Clerc P, Choukroun E, Elia N, Grimaud JP, Guibaud JP, Wroblewski S, Abergel E, Bogino E, Chauvel C, Dehant P, Simon M, Angioi M, Lemoine J, Lemoine S, Popovic B, Folliguet T, Maureira P, Huttin O, Selton Suty C, Cayla G, Delseny D, Leclercq F, Levy G, Macia JC, Maupas E, Piot C, Rivalland F, Robert G, Schmutz L, Targosz F, Albat B, Dubar A, Durrleman N, Gandet T, Munos E, Cade S, Cransac F, Bouisset F, Lhermusier T, Grunenwald E, Marcheix B, Fournier P, Morel O, Ohlmann P, Kindo M, Hoang MT, Petit H, Samet H, Trinh A, Huret B, Lecoq G, Morelle JF, Richard P, Derieux T, Monier E, Joret C, Lorgis L, Bouchot O, Eicher JC, Drogoul L, Meyer P, Lopez S, Tapia M, Teboul J, Elbeze JP, Mihoubi A, Bertrand B, Vanzetto G, Wittenberg O, Bach V, Martin C, Sauier C, Casset C, Castellant P, Gilard M, Bezon E, Choplain JN, Kallifa A, Nasr B, Jobic Y, Blanchard D, Lafont A, Pagny JY, Spaulding C, Abi Akar R, Fabiani JN, Zegdi R, Berrebi A, Puscas T, Desveaux B, Ivanes F, Quilliet L, Saint Etienne C, Bourguignon T, Aupy B, Perault R, Bonnet JL, Cuisset T, Lambert M, Grisoli D, Jaussaud N, Salaun E, Delomez M, Laghzaoui A, Savoye C, Beygui F, Bignon M, Roule V, Sabatier R, Ivascau C, Saplacan V, Saloux E, Bouchayer D, Claudel JP, Tremeau G, Diab C, Lapeze J, Pelissier F, Sassard T, Matz C, Monsarrat N, Carel I, Hepp A, Sibellas F, Curtil A, Dambrin G, Favereau X, Jegou A, Ghorayeb G, Guesnier L, Khoury W, Kucharski C, Pouzet B, Vaislic C, Cheikh-Khelifa R, Hilpert L, Maribas P, Gommeaux A, Hannebicque G, Hochart P, Paris M, Pecheux M, Fabre O, Guesnier L, Leborgne L, Mirode A, Peltier M, Trojette F, Carmi D, Tribouilloy C, Christiaens L, Mergy J, Corbi P, Raud Raynier P, Carillo S, Christophe C, Hueber A, Moulin F, Pinelli G, Cassat C, Darodes N, Pesteil F, Metz D, Aludaat C, Torossian F, Belle L, Mangin L, Chavanis N, Akret C, Cerisier A, Isaaz K, Favre JP, Fuzellier JF, Pierrard R, Jacquemin L, Roth O, Wiedemann JY, Bischoff N, Gavra G, Bourrely N, Digne F, Guyon P, Najjari M, Stratiev V, Bonnet N, Mesnildrey P, Attias D, Dreyfus J, Karila Cohen D, Laperche T, Nahum J, Scheuble A, Pouillot C, Rambaud G, Brauberger E, Ah Hot M, Allouch P, Beverelli F, Makowski S, Rosencher J, Aubert S, Grinda JM, Waldman T. Temporal Trends in Transcatheter Aortic Valve Replacement in France. J Am Coll Cardiol 2017; 70:42-55. [DOI: 10.1016/j.jacc.2017.04.053] [Citation(s) in RCA: 207] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 04/05/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
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Gilard M, Eltchaninoff H, Donzeau-Gouge P, Chevreul K, Fajadet J, Leprince P, Leguerrier A, Lievre M, Prat A, Teiger E, Lefevre T, Tchetche D, Carrié D, Himbert D, Albat B, Cribier A, Sudre A, Blanchard D, Rioufol G, Collet F, Houel R, Dos Santos P, Meneveau N, Ghostine S, Manigold T, Guyon P, Grisoli D, Le Breton H, Delpine S, Didier R, Favereau X, Souteyrand G, Ohlmann P, Doisy V, Grollier G, Gommeaux A, Claudel JP, Bourlon F, Bertrand B, Laskar M, Iung B. Late Outcomes of Transcatheter Aortic Valve Replacement in High-Risk Patients: The FRANCE-2 Registry. J Am Coll Cardiol 2017; 68:1637-1647. [PMID: 27712776 DOI: 10.1016/j.jacc.2016.07.747] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 06/30/2016] [Accepted: 07/12/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has revolutionized management of high-risk patients with severe aortic stenosis. However, survival and the incidence of severe complications have been assessed in relatively small populations and/or with limited follow-up. OBJECTIVES This report details late clinical outcome and its determinants in the FRANCE-2 (FRench Aortic National CoreValve and Edwards) registry. METHODS The FRANCE-2 registry prospectively included all TAVRs performed in France. Follow-up was scheduled at 30 days, at 6 months, and annually from 1 to 5 years. Standardized VARC (Valve Academic Research Consortium) outcome definitions were used. RESULTS A total of 4,201 patients were enrolled between January 2010 and January 2012 in 34 centers. Approaches were transarterial (transfemoral 73%, transapical 18%, subclavian 6%, and transaortic or transcarotid 3%) or, in 18% of patients, transapical. Median follow-up was 3.8 years. Vital status was available for 97.2% of patients at 3 years. The 3-year all-cause mortality was 42.0% and cardiovascular mortality was 17.5%. In a multivariate model, predictors of 3-year all-cause mortality were male sex (p < 0.001), low body mass index, (p < 0.001), atrial fibrillation (p < 0.001), dialysis (p < 0.001), New York Heart Association functional class III or IV (p < 0.001), higher logistic EuroSCORE (p < 0.001), transapical or subclavian approach (p < 0.001 for both vs. transfemoral approach), need for permanent pacemaker implantation (p = 0.02), and post-implant periprosthetic aortic regurgitation grade ≥2 of 4 (p < 0.001). Severe events according to VARC criteria occurred mainly during the first month and subsequently in <2% of patients/year. Mean gradient, valve area, and residual aortic regurgitation were stable during follow-up. CONCLUSIONS The FRANCE-2 registry represents the largest database available on late results of TAVR. Late mortality is largely related to noncardiac causes. Incidence rates of severe events are low after the first month. Valve performance remains stable over time.
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Affiliation(s)
- Martine Gilard
- Department of Cardiology, Brest University Hospital, Brest, France.
| | | | - Patrick Donzeau-Gouge
- Department of Cardiology and Surgery, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Karine Chevreul
- Department of URC-ECO and Cardiology, Creteil University Hospital, Paris, France
| | - Jean Fajadet
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | - Pascal Leprince
- Department of Surgery, Pitié Salpetrière University Hospital, Paris, France
| | - Alain Leguerrier
- Department of Cardiology and Surgery, Rennes University Hospital, Rennes, France
| | - Michel Lievre
- UMR and Department of Cardiology, Lyon University Hospital, Lyon, France
| | - Alain Prat
- Department of Cardiology and Surgery, Lille University Hospital, Lille, France
| | - Emmanuel Teiger
- Department of URC-ECO and Cardiology, Creteil University Hospital, Paris, France
| | - Thierry Lefevre
- Department of Cardiology and Surgery, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Didier Tchetche
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | - Didier Carrié
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | | | - Bernard Albat
- Department of Surgery, Montpellier University Hospital, Montpellier, France
| | - Alain Cribier
- Department of Cardiology, Rouen University Hospital, Rouen, France
| | - Arnaud Sudre
- Department of Cardiology and Surgery, Lille University Hospital, Lille, France
| | | | - Gilles Rioufol
- UMR and Department of Cardiology, Lyon University Hospital, Lyon, France
| | | | - Remi Houel
- Department of Surgery, Hospital Saint Joseph, Marseille, France
| | - Pierre Dos Santos
- Department of Cardiology, Bordeaux University Hospital, Bordeaux, France
| | - Nicolas Meneveau
- Department of Cardiology, Besancon University Hospital, Besancon, France
| | - Said Ghostine
- Department of Cardiology, Centre Cardiologique Marie Lannelongue, Le Plessis Robinson, France
| | - Thibaut Manigold
- Department of Cardiology, Nantes University Hospital, Nantes, France
| | - Philippe Guyon
- Department of Cardiology, Centre Cardiologique du Nord, Saint Denis, France
| | - Dominique Grisoli
- Department of Surgery, Marseille University Hospital, Marseille, France
| | - Herve Le Breton
- Department of Cardiology and Surgery, Rennes University Hospital, Rennes, France
| | - Stephane Delpine
- Department of Cardiology, Angers University Hospital, Angers, France
| | - Romain Didier
- Department of Cardiology, Brest University Hospital, Brest, France
| | - Xavier Favereau
- Department of Cardiology, Parly 2 Hospital, Le Chesnay, France
| | - Geraud Souteyrand
- Department of Cardiology, Clermont Ferrand University Hospital, Clermont Ferrand, France
| | - Patrick Ohlmann
- Department of Cardiology, Strasbourg University Hospital, Strasbourg, France
| | - Vincent Doisy
- Department of Surgery, Clinique du Tonkin, Lyon, France
| | - Gilles Grollier
- Department of Cardiology, Caen University Hospital, Caen, France
| | - Antoine Gommeaux
- Department of Cardiology, Hôpital Bois Bernard, Bois Bernard, France
| | | | | | - Bernard Bertrand
- Department of Cardiology, Grenoble University Hospital, Grenoble, France
| | - Marc Laskar
- Department of Surgery, Limoges University Hospital, Limoges, France
| | - Bernard Iung
- Department of Cardiology, Bichat University Hospital, Paris, France
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Leclercq F, Iemmi A, Lattuca B, Macia JC, Gervasoni R, Roubille F, Gandet T, Schmutz L, Akodad M, Agullo A, Verges M, Nogue E, Marin G, Nagot N, Rivalland F, Durrleman N, Robert G, Delseny D, Albat B, Cayla G. Feasibility and Safety of Transcatheter Aortic Valve Implantation Performed Without Intensive Care Unit Admission. Am J Cardiol 2016; 118:99-106. [PMID: 27184173 DOI: 10.1016/j.amjcard.2016.04.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 04/01/2016] [Accepted: 04/01/2016] [Indexed: 11/18/2022]
Abstract
Admission to the intensive care unit (ICU) is a standard of care after transcatheter aortic valve implantation (TAVI); however, the improvement of the procedure and the need to minimize the unnecessary use of medical resources call into question this strategy. We evaluated prospectively 177 consecutive patients who underwent TAVI. Low-risk patients, admitted to conventional cardiology units, had stable clinical state, transfemoral access, no right bundle branch block, permanent pacing with a self-expandable valve, and no complication occurring during the procedure. High-risk patients included all the others transferred to ICU. In-hospital events were the primary end point (Valve Academic Research Consortium 2 criteria). The mean age of patients was 83.5 ± 6.5 years, and the mean logistic EuroSCORE was 14.6 ± 9.7%. The balloon-expandable SAPIEN 3 valve was mainly used (n = 148; 83.6%), mostly with transfemoral access (n = 167; 94.4%). Among the 61 patients (34.5%) included in the low-risk group, only 1 (1.6%) had a minor complication (negative predictive value 98.4%, 95% confidence interval [CI] 0.91 to 0.99). Conversely, 31 patients (26.7%) from the high-risk group had clinical events (positive predictive value 26.7%, 95% CI 0.19 to 0.35), mainly conductive disorders requiring pacemaker (n = 26; 14.7%). In multivariate analysis, right bundle branch block (odds ratio [OR] 14.1, 95% CI 3.5 to 56.3), use of the self-expandable valve without a pacemaker (OR 5.5, 95% CI 2 to 16.3), vitamin K antagonist treatment (OR 3.8, 95% CI 1.1 to 12.6), and female gender (OR 2.6, 95% CI 1.003 to 6.9) were preprocedural predictive factors of adverse events. In conclusion, our results suggested that TAVI can be performed safely without ICU admission in selected patients. This strategy may optimize efficiency and cost-effectiveness of procedures.
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Affiliation(s)
- Florence Leclercq
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France.
| | - Anais Iemmi
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | - Benoit Lattuca
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | | | - Richard Gervasoni
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | - Francois Roubille
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | - Thomas Gandet
- Department of Cardiovascular Surgery, University Hospital of Montpellier, Montpellier, France
| | - Laurent Schmutz
- Department of Cardiology, University Hospital of Nîmes, Nîmes, France
| | - Mariama Akodad
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | - Audrey Agullo
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | - Marine Verges
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | - Erika Nogue
- Department of Medical Information, University Hospital of Montpellier, Montpellier, France
| | - Gregory Marin
- Department of Medical Information, University Hospital of Montpellier, Montpellier, France
| | - Nicolas Nagot
- Department of Medical Information, University Hospital of Montpellier, Montpellier, France
| | | | | | - Gabriel Robert
- Department of Cardiology, Clinique St Pierre, Perpignan, France
| | | | - Bernard Albat
- Department of Cardiovascular Surgery, University Hospital of Montpellier, Montpellier, France
| | - Guillaume Cayla
- Department of Cardiology, University Hospital of Nîmes, Nîmes, France
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Canaud L, Gandet T, Ozdemir BA, Albat B, Marty-Ané C, Alric P. Hybrid Aortic Repair of Dissecting Aortic Arch Aneurysm after Surgical Treatment of Acute Type A Dissection. Ann Vasc Surg 2016; 30:175-80. [DOI: 10.1016/j.avsg.2015.07.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 07/29/2015] [Accepted: 07/30/2015] [Indexed: 11/28/2022]
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Leclercq F, Akodad M, Macia JC, Gandet T, Lattuca B, Schmutz L, Gervasoni R, Nogue E, Nagot N, Levy G, Maupas E, Robert G, Targosz F, Vernhet H, Cayla G, Albat B. Vascular Complications and Bleeding After Transfemoral Transcatheter Aortic Valve Implantation Performed Through Open Surgical Access. Am J Cardiol 2015; 116:1399-404. [PMID: 26414600 DOI: 10.1016/j.amjcard.2015.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 08/01/2015] [Accepted: 08/01/2015] [Indexed: 12/20/2022]
Abstract
Major vascular complications (VC) remain frequent after transcatheter aortic valve implantation (TAVI) and may be associated with unfavorable clinical outcomes. The objective of this study was to evaluate the rate of VC after transfemoral TAVI performed using an exclusive open surgical access strategy. From 2010 to 2014, we included in a monocentric registry all consecutive patients who underwent transfemoral TAVI. The procedures were performed with 16Fr to 20Fr sheath systems. VC were evaluated within 30 days and classified as major or minor according to the Valve Academic Research Consortium 2 definition. The study included 396 patients, 218 were women (55%), median age was 85 years (81 to 88), and the median logistic Euroscore was 15.2% (11 to 23). The balloon-expandable SAPIEN XT and the self-expandable Medtronic Core Valve prosthesis were used in 288 (72.7%) and 108 patients (27.3%), respectively. The total length of the procedure was 68 ± 15 minutes including 13 ± 5 minutes for the open surgical access. Major and minor VC were observed in 9 (2.3%) and 16 patients (4%), respectively, whereas life-threatening and major bleeding concerned 18 patients (4.6%). The median duration of hospitalization was 5 days (interquartile range 2 to 7), significantly higher in patients with VC (7 days [5 to 15], p <0.001). Mortality at 1-month and 1-year follow-up (n = 26, 6.6%; and n = 67, 17.2%, respectively) was not related to major or minor VC (p = 0.6). In multivariable analysis, only diabetes (odds ratio 2.5, 95% confidence interval 1.1 to 6.1, p = 0.034) and chronic kidney failure (odds ratio 3.0, 95% confidence interval 1.0 to 9.0, p = 0.046) were predictive of VC, whereas body mass index, gender, Euroscore, and lower limb arteriopathy were not. In conclusion, minimal rate of VC and bleeding can be obtained after transfemoral TAVI performed using an exclusive surgical strategy, with a particular advantage observed in high-risk bleeding patients.
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Gaudard P, Mourad M, Eliet J, Zeroual N, Culas G, Rouvière P, Albat B, Colson P. Management and outcome of patients supported with Impella 5.0 for refractory cardiogenic shock. Crit Care 2015; 19:363. [PMID: 26453047 PMCID: PMC4600310 DOI: 10.1186/s13054-015-1073-8] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/20/2015] [Indexed: 12/20/2022]
Abstract
Introduction Cardiogenic shock refractory to standard therapy with inotropes and/or intra-aortic balloon pump is accompanied with an unacceptable high mortality. Percutaneous left ventricular assist devices may provide a survival benefit for these very sick patients. In this study, we describe our experience with the Impella 5.0 device used in the setting of refractory cardiogenic shock. Methods In this observational, retrospective, single-center study we included all the consecutive patients supported with Impella 5.0, between May 2008 and December 2013, for refractory cardiogenic shock. Patients’ baseline and procedural characteristics, hemodynamics and outcome to the first 48 h of support, to ICU discharge and day-28 visit were collected. Results A total of 40 patients were included in the study. Median age was 57 years and 87.5 % were male. Cardiogenic shock resulted from acute myocardial infarction in 17 patients (43 %), dilated cardiomyopathy in 12 (30 %) and postcardiotomy cardiac failure in 7 (18 %). In 15 patients Impella 5.0 was added to an ECMO to unload the left ventricle. The median SOFA score for the entire cohort prior to circulatory support was 12 [10–14] and the duration of Impella support was 7 [5–10] days. We observed a significant decrease of the inotrope score (10 [1–17] vs. 1 [0–9]; p = 0.04) and the lactate values (3.8 [1.7–5.9] mmol/L vs. 2.5 [1.5–3.4] mmol/L; p = 0.01) after 6 h of support with Impella 5.0. Furthermore, at Impella removal the patients’ left ventricular ejection fraction improved significantly (p < 0.001) when compared to baseline. Cardiac recovery, bridge to left ventricular assist device or heart transplantation was possible in 28 patients (70 %). Twenty-six patients (65 %) survived at day 28. A multivariate analysis showed a higher risk of mortality for patients with acute myocardial infarction (hazard ratio = 4.1 (1.2–14.2); p = 0.02). Conclusions Impella 5.0 allowed fast weaning of inotropes and might facilitate myocardial recovery. Despite high severity scores at admission, day-28 mortality rate was better than predicated.
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Affiliation(s)
- Philippe Gaudard
- Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHRU Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France. .,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR9214, 371 avenue du Doyen G. Giraud, 34295, Montpellier, France.
| | - Marc Mourad
- Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHRU Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France.
| | - Jacob Eliet
- Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHRU Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France.
| | - Norddine Zeroual
- Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHRU Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France.
| | - Geraldine Culas
- Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHRU Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France.
| | - Philippe Rouvière
- Department of Cardiac Surgery, Arnaud de Villeneuve Hospital, CHRU Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France.
| | - Bernard Albat
- Department of Cardiac Surgery, Arnaud de Villeneuve Hospital, CHRU Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France.
| | - Pascal Colson
- Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHRU Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France.
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Gandet T, Canaud L, Ozdemir BA, Ziza V, Demaria R, Albat B, Alric P. Factors favoring retrograde aortic dissection after endovascular aortic arch repair. J Thorac Cardiovasc Surg 2015; 150:136-42. [DOI: 10.1016/j.jtcvs.2015.03.042] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 03/22/2015] [Accepted: 03/29/2015] [Indexed: 11/30/2022]
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Ouazzani M, Sinquet JC, Frapier JM, Rouvière P, Albat B, Demaria R. [Description of the two surgical myocardial revascularisation techniques]. Soins 2015:44-46. [PMID: 26040141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A coronary artery bypass involves taking blood vessels from another part of the patient's body to bypass one or several major coronary stenoses. Coronary artery bypass using cardiopulmonary bypass and off-pump coronary artery bypass are the two methods used to revascularise the heart after a myocardial infarction.
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Romano-Bertrand S, Frapier JM, Calvet B, Colson P, Albat B, Parer S, Jumas-Bilak E. Dynamics of the surgical microbiota along the cardiothoracic surgery pathway. Front Microbiol 2015; 5:787. [PMID: 25628618 PMCID: PMC4292786 DOI: 10.3389/fmicb.2014.00787] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 12/22/2014] [Indexed: 11/13/2022] Open
Abstract
Human skin associated microbiota are increasingly described by culture-independent methods that showed an unexpected diversity with variation correlated with several pathologies. A role of microbiota disequilibrium in infection occurrence is hypothesized, particularly in surgical site infections. We study the diversities of operative site microbiota and its dynamics during surgical pathway of patients undergoing coronary-artery by-pass graft (CABG). Pre-, per-, and post-operative samples were collected from 25 patients: skin before the surgery, superficially and deeply during the intervention, and healing tissues. Bacterial diversity was assessed by DNA fingerprint using 16S rRNA gene PCR and Temporal Temperature Gel Electrophoresis (TTGE). The diversity of Operational Taxonomic Units (OTUs) at the surgical site was analyzed according to the stage of surgery. From all patients and samples, we identified 147 different OTUs belonging to the 6 phyla Firmicutes, Actinobacteria, Proteobacteria, Bacteroidetes, Cyanobacteria, and Fusobacteria. High variations were observed among patients but common themes can be observed. The Firmicutes dominated quantitatively but were largely encompassed by the Proteobacteria regarding the OTUs diversity. The genera Propionibacterium and Staphylococcus predominated on the preoperative skin, whereas very diverse Proteobacteria appeared selected in peri-operative samples. The resilience in scar skin was partial with depletion in Actinobacteria and Firmicutes and increase of Gram-negative bacteria. Finally, the thoracic operative site presents an unexpected bacterial diversity, which is partially common to skin microbiota but presents particular dynamics. We described a complex bacterial community that gathers pathobionts and bacteria deemed to be environmental, opportunistic pathogens and non-pathogenic bacteria. These data stress to consider surgical microbiota as a “pathobiome” rather than a reservoir of individual potential pathogens.
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Affiliation(s)
- Sara Romano-Bertrand
- Equipe Pathogènes et Environnements, UMR 5119 ECOSYM, Université Montpellier 1 Montpellier, France ; Département d'Hygiène Hospitalière, Centre Hospitalier Régional Universitaire de Montpellier Montpellier, France
| | - Jean-Marc Frapier
- Service de Chirurgie Thoracique et Cardiovasculaire, Centre Hospitalier Régional Universitaire de Montpellier Montpellier, France
| | - Brigitte Calvet
- Département de Réanimation de Chirurgie Cardiothoracique, Centre Hospitalier Régional Universitaire de Montpellier Montpellier, France
| | - Pascal Colson
- Département de Réanimation de Chirurgie Cardiothoracique, Centre Hospitalier Régional Universitaire de Montpellier Montpellier, France
| | - Bernard Albat
- Service de Chirurgie Thoracique et Cardiovasculaire, Centre Hospitalier Régional Universitaire de Montpellier Montpellier, France
| | - Sylvie Parer
- Equipe Pathogènes et Environnements, UMR 5119 ECOSYM, Université Montpellier 1 Montpellier, France ; Département d'Hygiène Hospitalière, Centre Hospitalier Régional Universitaire de Montpellier Montpellier, France
| | - Estelle Jumas-Bilak
- Equipe Pathogènes et Environnements, UMR 5119 ECOSYM, Université Montpellier 1 Montpellier, France ; Département d'Hygiène Hospitalière, Centre Hospitalier Régional Universitaire de Montpellier Montpellier, France
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Malaud E, Merle D, Piquer D, Molina L, Salvetat N, Rubrecht L, Dupaty E, Galea P, Cobo S, Blanc A, Saussine M, Marty-Ané C, Albat B, Meilhac O, Rieunier F, Pouzet A, Molina F, Laune D, Fareh J. Local carotid atherosclerotic plaque proteins for the identification of circulating biomarkers in coronary patients. Atherosclerosis 2014; 233:551-558. [PMID: 24530963 DOI: 10.1016/j.atherosclerosis.2013.12.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/18/2013] [Accepted: 12/09/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To identify circulating biomarkers that originate from atherosclerotic vulnerable plaques and that could predict future cardiovascular events. METHODS After a protein enrichment step (combinatorial peptide ligand library approach), we performed a two-dimensional electrophoresis comparative analysis on human carotid plaque protein extracts (fibrotic and hemorrhagic atherosclerotic plaques). In silico analysis of the biological processes was applied on proteomic data. Luminex xMAP assays were used to quantify inflammatory components in carotid plaques. The systemic quantification of proteins originating from vulnerable plaques in blood samples from patients with stable and unstable coronary disease was evaluated. RESULTS A total of 118 proteins are differentially expressed in fibrotic and hemorrhagic plaques, and allowed the identification of three biological processes related to atherosclerosis (platelet degranulation, vascular autophagy and negative regulation of fibrinolysis). The multiplex assays revealed an increasing expression of VEGF, IL-6, IL-8, IP-10 and RANTES in hemorrhagic as compared to fibrotic plaques (p<0.05). Measurement of protein expressions in plasmas from patients with stable and unstable coronary disease identified a combination of biomarkers, including proteins of the smooth muscle cell integrity (Calponin-1), oxidative stress (DJ-1) and inflammation (IL-8), that allows the accurate classification of patients at risk (p=0.0006). CONCLUSION Using tissue protein enrichment technology, we validated proteins that are differentially expressed in hemorrhagic plaques as potential circulating biomarkers of coronary patients. Combinations of such circulating biomarkers could be used to stratify coronary patients.
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Affiliation(s)
- Eric Malaud
- UMR3145 CNRS Bio-Rad, SysDiag, Montpellier, France
| | | | | | | | | | | | | | | | - Sandra Cobo
- UMR3145 CNRS Bio-Rad, SysDiag, Montpellier, France
| | | | - Max Saussine
- Vascular Surgery Department, Arnaud de Villeneuve Hospital, CHU Montpellier, France
| | - Charles Marty-Ané
- Vascular Surgery Department, Arnaud de Villeneuve Hospital, CHU Montpellier, France
| | - Bernard Albat
- Vascular Surgery Department, Arnaud de Villeneuve Hospital, CHU Montpellier, France
| | | | | | - Agnes Pouzet
- Bio-Rad Laboratories, Marnes la Coquette, France
| | | | - Daniel Laune
- UMR3145 CNRS Bio-Rad, SysDiag, Montpellier, France
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Canaud L, Alric P, Gandet T, Ozdemir B, Albat B, Marty-Ane C. Open Surgical Secondary Procedures after Thoracic Endovascular Aortic Repair. Eur J Vasc Endovasc Surg 2013; 46:667-74. [DOI: 10.1016/j.ejvs.2013.08.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 08/18/2013] [Indexed: 12/01/2022]
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Agullo A, Battistella P, Rouviere P, Eliet J, Gaudard P, Demaria R, Frapier JM, Piot C, Sportouch C, Albat B. Anatomical findings after amplatzer occluder to treat aortic regurgitation on left ventricular assist device patient. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht312.4347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Du Cailar C, Gandet T, Du Cailar M, Albat B. A simple sheath removal after open trans-femoral catheterization procedure: the ZIP technique. Eur J Cardiothorac Surg 2013; 45:746-8. [DOI: 10.1093/ejcts/ezt384] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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36
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Al Yamani MI, Frapier JM, Battistella PD, Albat B. Right coronary cusp perforation after mitral valve replacement. Interact Cardiovasc Thorac Surg 2012; 16:387-8. [PMID: 23243033 DOI: 10.1093/icvts/ivs522] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Secondary to leaflet injury, which is a well-known technical mistake, aortic regurgitation can occur during mitral valve replacement or repair. In most cases, the left or the non-coronary cusps are affected. For the first time, we report the case of a patient who had severe aortic regurgitation due to right coronary cusp perforation after mitral valve replacement. This complication was not identified until reoperation. Had transoesophageal echocardiography (TOE) been used during the first procedure, a delayed reoperation could have been avoided. During mitral surgery, every aortic cusp is at risk and peroperative TOE should be a mandatory procedure.
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Affiliation(s)
- Mohammed I Al Yamani
- Department of Thoracic and Cardiovascular Surgery, Arnaud de Villeneuve Hospital, CHRU Montpellier, Montpellier, France
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Gilard M, Eltchaninoff H, Iung B, Donzeau-Gouge P, Chevreul K, Fajadet J, Leprince P, Leguerrier A, Lievre M, Prat A, Teiger E, Lefevre T, Himbert D, Tchetche D, Carrié D, Albat B, Cribier A, Rioufol G, Sudre A, Blanchard D, Collet F, Dos Santos P, Meneveau N, Tirouvanziam A, Caussin C, Guyon P, Boschat J, Le Breton H, Collart F, Houel R, Delpine S, Souteyrand G, Favereau X, Ohlmann P, Doisy V, Grollier G, Gommeaux A, Claudel JP, Bourlon F, Bertrand B, Van Belle E, Laskar M. Registry of transcatheter aortic-valve implantation in high-risk patients. N Engl J Med 2012; 366:1705-15. [PMID: 22551129 DOI: 10.1056/nejmoa1114705] [Citation(s) in RCA: 938] [Impact Index Per Article: 78.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Transcatheter aortic-valve implantation (TAVI) is an emerging intervention for the treatment of high-risk patients with severe aortic stenosis and coexisting illnesses. We report the results of a prospective multicenter study of the French national transcatheter aortic-valve implantation registry, FRANCE 2. METHODS All TAVIs performed in France, as listed in the FRANCE 2 registry, were prospectively included in the study. The primary end point was death from any cause. RESULTS A total of 3195 patients were enrolled between January 2010 and October 2011 at 34 centers. The mean (±SD) age was 82.7±7.2 years; 49% of the patients were women. All patients were highly symptomatic and were at high surgical risk for aortic-valve replacement. Edwards SAPIEN and Medtronic CoreValve devices were implanted in 66.9% and 33.1% of patients, respectively. Approaches were either transarterial (transfemoral, 74.6%; subclavian, 5.8%; and other, 1.8%) or transapical (17.8%). The procedural success rate was 96.9%. Rates of death at 30 days and 1 year were 9.7% and 24.0%, respectively. At 1 year, the incidence of stroke was 4.1%, and the incidence of periprosthetic aortic regurgitation was 64.5%. In a multivariate model, a higher logistic risk score on the European System for Cardiac Operative Risk Evaluation (EuroSCORE), New York Heart Association functional class III or IV symptoms, the use of a transapical TAVI approach, and a higher amount of periprosthetic regurgitation were significantly associated with reduced survival. CONCLUSIONS This prospective registry study reflected real-life TAVI experience in high-risk elderly patients with aortic stenosis, in whom TAVI appeared to be a reasonable option. (Funded by Edwards Lifesciences and Medtronic.).
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Affiliation(s)
- Martine Gilard
- Centre Hospitalier Universitaire (CHU) Brest, Brest, France.
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Malaud E, Piquer D, Merle D, Molina L, Guerrier L, Boschetti E, Saussine M, Marty-Ané C, Albat B, Fareh J. Carotid atherosclerotic plaques: Proteomics study after a low-abundance protein enrichment step. Electrophoresis 2012; 33:470-82. [DOI: 10.1002/elps.201100395] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lansac E, Di Centa I, Sleilaty G, Crozat EA, Bouchot O, Hacini R, Blin D, Doguet F, Bessou JP, Albat B, De Maria R, Villemot JP, Portocarrero E, Acar C, Chatel D, Lopez S, Folliguet T, Debauchez M. An aortic ring: From physiologic reconstruction of the root to a standardized approach for aortic valve repair. J Thorac Cardiovasc Surg 2010; 140:S28-35; discussion S45-51. [DOI: 10.1016/j.jtcvs.2010.08.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 08/02/2010] [Accepted: 08/05/2010] [Indexed: 10/18/2022]
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Abstract
We report the case of a 50-year-old man admitted for cardiac tamponade. He was diagnosed with acute pneumonia. He had no previous medical history, but exhibited a body mass index of 41. Two days before admission, he complained of chest pain irradiating to the neck lateral side. Massive cardiac tamponade developed over 48 hours. There was no obvious cause for immunodepression. Pericardial puncture was ineffective, due to obesity and fluid high viscosity. Surgery was undertaken (Marfan intervention). Pericardial fluid was found to be purulent; direct examination revealed nocardia as bacteria with typical filamentous, branching rods. Despite adapted antibiotic treatment the patient died within a few hours. Acute pericarditis due to Nocardia is discussed.
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Affiliation(s)
- Francois Roubille
- Department of Cardiology, Arnaud de Villeneuve University Hospital, Montpellier, France.
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Picichè M, Demaria RG, Frapier JM, Albat B. Supravalvular aortic stenosis of the diffuse type: 29 years follow-up after aortic endarterectomy and symmetric enlargement of the ascending aorta and of the three coronary sinuses. J Cardiovasc Med (Hagerstown) 2008; 9:1268-70. [PMID: 19001936 DOI: 10.2459/jcm.0b013e328316bc10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Supravalvular aortic stenosis is a rare congenital anomaly characterized by variable amounts of left ventricular outflow tract obstruction distal to the aortic valve. Macroscopically, it is categorized into three morphologic subtypes: membranous, hourglass, and diffuse. The diffuse type is the most rare, and its surgical repair is the most challenging due to variable length of ascending aorta hypoplasia. Surgical treatment options of supravalvular aortic stenosis are well established for the membranous and hourglass type, whereas they are challenging and less well defined for the diffuse type. We present a case of long-term follow-up (29 years) after a very complex surgical repair of supravalvular aortic stenosis of the diffuse type, with focus on technical aspects. To our knowledge, the present case represents one of the longest follow-up routines in the English language literature of surgical treatment of supravalvular aortic stenosis.
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Affiliation(s)
- Marco Picichè
- Cardiovascular Surgery Department, CHU Arnaud de Villeneuve, Montpellier University Faculty of Medicine, Montpellier, France.
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Mukaddirov M, Demaria RG, Perrault LP, Frapier JM, Albat B. Reconstructive surgery of postinfarction left ventricular aneurysms: techniques and unsolved problems. Eur J Cardiothorac Surg 2008; 34:256-61. [DOI: 10.1016/j.ejcts.2008.03.061] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Revised: 03/11/2008] [Accepted: 03/12/2008] [Indexed: 10/22/2022] Open
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Mukaddirov M, Frapier JM, Demaria RG, Albat B. Surgical treatment of postinfarction anterior left ventricular aneurysms: linear vs. patch plasty repair. Interact Cardiovasc Thorac Surg 2007; 7:256-61. [DOI: 10.1510/icvts.2007.160093] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Raad E, Demaria R, Rouvière P, Prudhomme M, Frapier JM, Dauzat M, Albat B. Les anévrismes des artères digestives. À propos d'un cas clinique de localisation anévrismale multiple et revue de la littérature. ACTA ACUST UNITED AC 2007; 32:216-20. [PMID: 17658233 DOI: 10.1016/j.jmv.2007.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 06/13/2007] [Indexed: 11/29/2022]
Abstract
Visceral artery aneurysms constitute a rare vascular disease, with a risk of rupture associated to a high mortality. Often asymptomatic, they are discovered following a routine radiological examination. We present the case of a 71-year-old patient with multiple aneurysms involving the celiac trunk, the splenic artery, and the common hepatic artery. The surgical treatment consisted of an aortohepatic bypass using polytetrafluoroethylene prosthesis, after exclusion of all the aneurysms. The angiography and postoperative angioscan demonstrated the perfect patency of the prosthesis, totally excluding the aneurysms. Given the variety of presentations and the absence of precise predictive factors, there is no therapeutic consensus so far. Surgery is the first therapeutic choice. Endovascular treatment by angioembolization must be reserved for particular conditions. The purpose of this article is to propose the best therapeutic approach on the basis of evidence in the literature.
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Affiliation(s)
- E Raad
- Service de chirurgie cardiovasculaire, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, 371, avenue du Doyen-G.-Giraud, 34295 Montpellier, France
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Affiliation(s)
- Marco Picichè
- Service de Chirurgie Cardio-Vasculaire, Chu Arnaud de Villeneuve, Montpellier, France
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46
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Mukaddirov M, Demaria R, Frapier JM, Albat B. [Detection and surgical treatment of induced ventricular tachycardia in postinfarction left ventricular aneurysm]. Kardiologiia 2007; 47:94-96. [PMID: 18260901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A clinical case of a patient aged 56 years with postinfarction left ventricular aneurysm not complicated with ventricular tachyarrhythmias is presented electrophysiological investigation. Left ventricular aneurysmectomy supplemented with endocardial cryodestruction was carried out. At electrophysiological investigation after surgery ventricular tachycardia could not be induced. In 2 years postoperatively no ventricular tachyarrhythmias were noted. The condition of the patient is satisfactory, corresponds to NYHA class I.
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Mukaddirov M, Demaria R, Frapier GM, Albat B. [Extended circular endocardial cryodestruction without mapping at postinfarction ventricular tachycardia]. Khirurgiia (Mosk) 2007:72-5. [PMID: 17902252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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Mukaddirov M, Frapier GM, Demaria R, Albat B. [Left-ventricle aneuryzmectomy with endocardial cryodestruction as long-time preparation for heart transplantation]. Khirurgiia (Mosk) 2007:70-71. [PMID: 18236623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Picichè M, Demaria RG, Miguel B, Frapier JM, Rouviere P, Battistella P, Albat B. Recurrence of postoperative aortic fistulas: is there an ideal method of prevention? A case report. MINERVA CHIR 2006; 61:445-50. [PMID: 17159753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
There are very few cases in English literature of recurrent postoperative aortic fistulas (RPAFs). These are neo-communications between the aortic bloodstream and the lumen of contiguous organs which occur after unpredictable periods from surgical treatment of a previous fistula. The supradiaphragmatic aorta may fistulize into the airways, pulmonary circulation, oesophagus, and cardiac chambers; the infradiaphragmatic aorta into the intestine, stomach, and vena cava. According to the etiology, aortic fistulas are categorized as postoperative (or secondary) and spontaneous (or primary), and RPAF may be considered a subgroup of secondary fistulas. They may recur even more times in the same patient, hence the role of prevention is of the utmost importance. The simultaneous respect of different surgical principles is crucial to make the risk of recurrence less likely. Surgical treatment represents a real challenge due to the emergency conditions and redo nature of operations. Mortality rate is very high. In this article, we describe a case of recurrent aorto-duodenal communication, we discuss the principles of prevention both for the supra and infradiaphragmatic aorta, we introduce some modifications to the classic categorization and we present the first RPAF literature review.
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Affiliation(s)
- M Picichè
- Department of Cardiovascular Surgery, Arnaud de Villeneuve Hospital, Montpellier Teaching Hospital, Montpellier University, Avenue Doyen G. Giraud, 32495 Montpellier, France.
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Demaria RG, Picichè M, Vernhet H, Battistella P, Rouvière P, Frapier JM, Albat B. Internal thoracic arterial grafts evaluation by multislice CT scan: a preliminary study. J Card Surg 2006; 19:475-80. [PMID: 15548177 DOI: 10.1111/j.0886-0440.2004.04102.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM The internal thoracic artery (ITA) has a better long-term patency than saphenous veins, and anastomosis between ITA and the left anterior descending artery (LAD) represents the "gold-standard" of surgical myocardial revascularization. The aim of this study is to evaluate the multidetector multislice CT Scan (MCTS) as a means of postoperative evaluation of ITA coronary artery bypass grafts. METHODS Twenty-eight patients having been operated on for coronary artery bypass with ITA during a 6-months period, benefited, 7 days after surgery, from a patency and anastomotic site control of ITA with a MCTS associated with cardiac gating (Light Speed, General Electric, USA). RESULTS Internal thoracic artery bypasses are visualized perfectly on all their courses, with possibility of 3D reconstructions, showing the relationship between cardiac cavities and the arterial bypasses. The anastomotic site on the LAD was, in selected cases, perfectly visualized. Sequential bypasses with left ITA are well visualized as well as T or Y right-to-left ITA grafts. However, surgical clips create some image artefacts. CONCLUSIONS The postoperative control of ITAs are possible by MCTS with a satisfactory resolution. This makes it possible to check the patency of ITAs, their course on the heart surface, and the location and quality of anastomosis with a noninvasive reproductive method.
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Affiliation(s)
- R G Demaria
- Department of Cardiovascular Surgery, Arnaud de Villenueve Hospital, Montpellier Teaching Hospital, Montpellier I University, France.
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